WEDNESDAY, Aug. 28, 2002 (HealthDayNews) -- Women diagnosed with breast cancer before age 40 who also have a family history of either breast or ovarian cancer are at a much greater risk of getting ovarian cancer than are young breast cancer patients without such a family history.
That's the finding of a new Swedish study that also suggests these high-risk women should be followed closely, offered counseling and perhaps consider removal of their ovaries as a preventive measure. A report on the research appears today on the Web site of The Lancet.
Dr. Kjell Bergfeldt and his colleagues from the Karolinska Institute in Stockholm followed more than 30,00 women, all under age 70, when they were diagnosed with breast cancer. Then they obtained information about the medical histories of 146,000 of the women's first-degree relatives, including parents, children and siblings.
While it is known that women with breast cancer who have mutations in the so-called breast cancer genes, BRCA1 and BRCA2, are at increased risk for ovarian cancer, these mutations are rare, the authors note. So, the researchers decided to evaluate family history to see whether that might help them account for risk beyond having the breast cancer genes.
After six years of follow up, they found that women diagnosed with breast cancer were twice as likely to get ovarian cancer as women in the general population.
Family history boosted the risk even more.
Those women with breast cancer diagnosed before age 40 and a family history of breast cancer had a five- or six-fold increased risk for ovarian cancer. Women with breast cancer and a family history of ovarian cancer had a 17-fold increased risk for ovarian cancer, compared with the general population.
Put another way, women with breast cancer and a family history of ovarian cancer have an almost 10 percent risk of getting ovarian cancer before age 70. In contrast, about 1 percent of American and northern European women are at risk for getting the disease before their 70th birthday.
Women at high risk for ovarian cancer should be closely followed by their doctors and offered counseling, Bergfeldt says.
"Since the purpose of the counseling is to achieve early detection of a severe disease, the counseling should be performed by a physician, preferably a gynecologist familiar with ultrasound imaging," he says.
Ultrasound is one method used to detect ovarian cancer, which will be diagnosed in about 23,000 women this year in the United States, according to the American Cancer Society. Identifying women at risk for ovarian cancer is particularly crucial because the disease is difficult to detect early, even with ultrasound and pelvic exams and a blood test that detects antigens that fight off ovarian tumors.
Preventive removal of the ovaries, called a prophylactic oophorectomy, should also be discussed, Bergfeldt says. "If there will be discussion concerning removal of the ovaries, I think that additional experts should be included, that is, oncologists and specialists in genetics. Even psychologists might be included, since removal of healthy organs for prophylactic reasons is a difficult decision."
How willing are women in this high-risk group to undergo ovary removal?
"It is difficult to answer such a question," Bergfeldt says. "Every individual handles risk estimates concerning their health in different ways. Some are willing to be very radical and take every opportunity to reduce the risk, while others are not."
The study supports what experts in the field have suspected and provides a practical way for doctors to assess their patient's risk, says Dr. Robin Farias-Eisner, a gynecologic oncologist and associate professor of obstetrics and gynecology at the David Geffen School of Medicine at University of California, Los Angeles.
"This study supports the concept that there is a connection between unknown genes and cancer susceptibility for ovarian cancer, and that in the absence of these [as yet] unknown genetic risk factors, we can use family history of breast or ovarian cancer as a predictor of those individuals at risk," he says.
"BRCA 1 and BRCA 2 account for less than 5 percent of all breast cancer patients [risk]," he adds.
To account for other risks, Farias-Eisner and others are working to identify the biomarkers that increase risk. "A biomarker is a gene that is turned on in the presence of disease such as ovarian cancer," he explains.
Next, the latest findings should be replicated by other researchers, Farias-Eisner says.
What To Do
For more information on ovarian cancer, see Johns Hopkins University. For information on cancer risk and family history, see FORCE.
